Question

The physician has prescribed timolol (Timoptic) ophthalmic drops for a client with primary open angle glaucoma. To decrease the systemic effects associated with the medication's use, the nurse should: A. Tell the client to remain in bed five minutes after the drops are instilled. B. Ask the client to sit upright while the drops are instilled. C. Apply pressure to the inner canthus when instilling the drops. D. Reduce the amount of light in the room when the drops are instilled.

Short answer

Answer: C. Apply pressure to the inner canthus when instilling the drops.

Step-by-step solution

Identify the different options given in the question

There are four options provided in the question: A. Tell the client to remain in bed five minutes after the drops are instilled. B. Ask the client to sit upright while the drops are instilled. C. Apply pressure to the inner canthus when instilling the drops. D. Reduce the amount of light in the room when the drops are instilled.

Evaluate the options

We need to go through each option separately and analyze whether it could help decrease the systemic effects of the medication. A. Remaining in bed may not directly affect the absorption of the eye drops and decrease the systemic effects of the medication. B. Sitting upright might help to prevent the eye drops from dripping out, but it doesn't specifically address decreasing systemic effects. C. Applying pressure to the inner canthus (the point where the upper and lower eyelids meet, near the nose) can help prevent the eye drops from draining into the tear ducts, which lead to the nasal cavity and the gastrointestinal tract. By preventing drainage, less of the medication will be absorbed systemically, thus reducing the systemic effects. D. Reducing the light in the room will not have an impact on systemic absorption of the medication.

Determine the best option

Based on our evaluation of the given options, the best choice to decrease the systemic effects associated with Timolol is: C. Apply pressure to the inner canthus when instilling the drops.

Key concepts

Timolol Ophthalmic Drops

Timolol ophthalmic drops are a common medication prescribed for managing conditions such as primary open angle glaucoma. They belong to a class of drugs known as beta-blockers, which work by decreasing the production of fluid inside the eye, thereby lowering the intraocular pressure. Correct administration of these drops is crucial to maximize their benefits and minimize potential side effects.

For effective application, the patient should tilt their head back, pull their lower eyelid to create a small pocket, and carefully place the drops into the pocket without touching the dropper to the eye or eyelid to avoid contamination. After administering, it's recommended to close the eyes for a couple of minutes and apply pressure to the inner canthus — the practice known as punctal occlusion — to prevent the medication from draining away from the eye, which could reduce its efficacy and increase the risk of systemic absorption.

• Tip: Avoid blinking or rubbing the eye immediately after instillation to prevent the drops from being expelled.
• Case: If a patient is prescribed more than one type of eye drop, they should wait at least five minutes before applying the second type to ensure proper absorption.

Primary Open-angle Glaucoma

Primary open-angle glaucoma (POAG) is a progressive eye condition characterized by the gradual loss of optic nerve fibers, resulting in a decrease of peripheral vision and potentially leading to blindness if left untreated. One significant aspect of POAG is that it often presents without pain or noticeable symptoms until significant vision loss has occurred, which is why it is sometimes called the 'sneak thief of sight.'

The primary risk factor for POAG is elevated intraocular pressure (IOP), which can be caused by an imbalance in the production and drainage of aqueous humor, the fluid that nourishes the eye. Long-term management often involves medications like timolol ophthalmic drops to lower IOP and prevent further nerve damage. Routine eye exams are essential for early detection and monitoring of this condition.

• Fact: POAG is the most common form of glaucoma, affecting millions of people worldwide.
• Advice: Patients diagnosed with POAG should adhere to their prescribed treatment plans and attend regular eye check-ups.

Systemic Effects of Medication

When eye drops like timolol are instilled, a portion may be absorbed into the bloodstream, potentially leading to systemic effects — meaning that parts of the body other than the eyes may be affected. For medications like timolol, when used for treating POAG, systemic effects can include changes in heart rate, blood pressure, and respiratory function due to its beta-blocking properties.

Minimizing these systemic effects is a crucial aspect of treatment, especially in patients who may have comorbid conditions that could be exacerbated by these side effects. Techniques such as punctal occlusion, where pressure is applied to the inner canthus after instillation, can be used to reduce systemic absorption. This method blocks the tear duct, which connects to the nasal cavity and can transport the medication into the systemic circulation more quickly. Educating patients on the importance of these techniques during administration can significantly enhance the safety and efficacy of their treatment.

• Consideration: For individuals on beta-blockers or with pre-existing respiratory conditions, it's vital to monitor for systemic side effects and consult healthcare providers regularly.
• Recommendation: Always report any unusual symptoms to a healthcare professional promptly after starting a new ocular medication.